Choosing Between In-Office Procedures and Surgery for BPH
Benign prostatic hyperplasia or BPH is a non-cancerous enlargement of the prostate gland. It is extremely common with about 50% of men over 50, and 80% of men over 80, suffering from its symptoms. While BPH is very common, there is a lot of confusing information that can delay patients from receiving the most effective treatment. Many men live with the lower urinary tract symptoms associated with BPH for years before they pursue a treatment option. Many are then bombarded by advertisements telling them that herbs may shrink the prostate. Having read this website you know that these claims are questionable.
However, even when a patient has decided to pursue a BPH treatment option at their urologist’s office, there are many considerations that must be considered. One of the first decisions to make with your urologist is whether to undergo a minimally invasive in office procedure or pursue surgery – a surgical procedure known as Transurethral Resection of the Prostate or TURP.
When speaking to Dr. Engel, there is a relatively straightforward step-by-step process toward relief. To maximize results and to offer patients the most comfortable progression of treatment, we try to start with the least aggressive option possible. Patients will often be encouraged to improve their lifestyle in the form of better diet and exercise. They may also be started on medication to improve their symptoms. Of course, medication does not address the underlying problem, and eventually, will no longer offer sufficient relief.
Eventually, the patient may have to decide between in-office therapies and surgery. Typically, Dr. Engel pursues the in-office strategy first, considering it a “free swing” at relief. He performs a simple, quick procedure known as Transurethral Needle Ablation, or TUNA, for short. This procedure deploys radiofrequency waves into the prostate to ablate or destroy excess prostatic tissue. Over the course of six to eight weeks after the procedure, this tissue is reabsorbed into the body and symptoms progressively improve. For most patients, symptoms remain at bay for about five years, at which point they start to gradually reappear. Many patients, impressed by the minimally invasive nature and quick recovery of the procedure, often ask to have it done again, with the hopes of another five years of relief. This is often achievable. Risks of the procedure will be discussed during consultation.
Some patients will not get adequate relief from an office treatment, recur early, or just want a procedure with a higher success rate and faster results. Some patients have problems associated with their BPH which require more aggressive obstruction relief such as infections, bladder stones, severe urinary retention or even kidney failure. These patients are typically offered a TURP. During this procedure, Dr. Engel shaves away tissue within the prostate to mechanically shrink it, offering patients immediate relief. TURP has potential risks and considerations which will be discussed during consultation. You can learn more by watching Dr. Engel’s TURP video here.
Whether patients ultimately opt for the in-office option or the surgical path, choosing a qualified and experienced urologist such as Dr. Engel who has served the Washington, DC area for over 20 years often results in a safer and more effective procedure. For more information, and to understand your options, we encourage you to schedule a consultation with us during which time Dr. Engel will explain the pros and cons of each procedure and guide you in the direction that he feels best for your circumstance.